After Birth
Female Reproductive System & Breast
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/G8_F1.jpg"}},{"insert":"\n\n"},{"insert":"The customarily stern face of the director is split by a grin which would shame the Cheshire Cat.\n\n\u0022Of course! I knew from the day you started working here that you\u0027d bring great honors upon this hospital!\u0022, he proclaims.\n\n\u0022Wh-why are you all here?\u0022, you manage to ask.\n\n\u0022My dear fellow!\u0022, says the director effusively, \u0022You\u0027ve been awarded the Wolf Prize in medicine!\u0022\n\nThe crowd breaks into applause. You begin to feel ecstatic.\n\n\u0022I do deserve it\u0022, you think, as you gaze around the room at your beaming colleagues.\n\nYour attention is suddenly drawn to the head nurse, who looks worried and slightly annoyed.\n\nNearly drowned out by the thunderous applause, she is shouting \u0022Doctor! Doctor!! Wake up!!\u0022\n\nAnd thus, you are rudely awakened from your delightful daydream ....\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/G8_F2.jpg"}},{"insert":"\n\n"},{"insert":"\u0022Doctor, Mrs. Wolfe has developed vaginal bleeding. You had better come take a look\u0022, she says, after making sure you\u0027re fully awake.\n\nYou recall that Mrs. Wolfe, a 32-year-old stay-at-home mom, delivered her fifth child vaginally four hours ago, following an uncomplicated pregnancy.\n\nThe delivery was significant for a prolonged second stage of labor. The placenta and products were completely expelled.\n\nThe child weighed 2.9 kg, and was doing well.\n\nMrs. Wolfe\u0027s medical, surgical and obstetric histories were equally unremarkable.\n\nYou head to her room immediately.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/G8_F3.jpg"}},{"insert":"\n\n"},{"insert":"You note that Mrs. Wolfe\u0027s pulse is 100 bpm, while her blood pressure is 100\/70 mmHg.\n\nYou quickly flip through her charts to find that her pulse was 82 bpm and blood pressure 120\/80 mmHg when last recorded, around an hour ago.\n\nFearing primary postpartum hemorrhage, you alert your team, insert a wide-bore cannula, start a normal saline drip and call the blood bank to reserve two units of A positive packed red cells.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/G8_F4.jpg"}},{"insert":"\n\n"},{"insert":"Mrs. Wolfe\u0027s uterus feels boggy and poorly contracted when palpated abdominally. You note an active vaginal bleed, and proceed to exclude any local trauma.\n\nHer lab results are as follows:\n\nWBC: 10.2 x 10^3\/mm3 (5.6 - 16.9)\nRBC: 4.2 x 10^6\/ mm3 (2.7 - 4.4)\nHemoglobin: 11.2 g\/dL (9.5 - 15)\nPlatelets: 170 x10^3\/mm3 (146 - 430)\nBlood urea nitrogen: 10 mg\/dL (3-11)\n"}]}
4
{"ops":[{"insert":"What will you do now?\n"}]}
1. Tightly pack the uterus with layered gauze, under direct visualization
2. Massage the uterus, and inject an intravenous bolus of oxytocin
3. Apply bimanual pressure, and keep her under strict observation
6
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8
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9
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5
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7
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